If you are a new participant at Just in Time you are required to fill out the application below.
After you submit your application a Youth Services Coordinator will be in contact with you within two business days.
Where is your current residence or past residence?
–Choose One–San Diego CountyContra Costa County / Alameda
1. Are you a former foster youth?
–Choose One–YesNo, I am a current foster youthNo, I have never been in foster care
Give a detailed description on why you are applying to JIT services:
2. How many total years combined were you in foster care?
–Choose One–less than 1 year1 year2 years3 years4 years5 years6 years7 years8 years9 years10 years11 years12 years13 years14 years15 years16 years17 years18 years19 years20+ years
3. How many placements did you experience while you were in foster care?
4. How did you hear about JIT?
–Choose One–Family/FriendInternet SearchFacebook/TwitterILS or Agency Case ManagerJIT PresentationCollege AdvisorTV/Radio/Newspaper
5. Date of Birth (Example: 01/11/92):
7. Ethnicity (please check one):
–Choose One–Black/African AmericanHispanic/Latino/SpanishNative AmericanAsian/Pacific IslanderWhite/CaucasianMultiracialOther (not listed)
8. How many children do you have?
–Choose One–NoneOneTwo or more
9. What is your source of healthcare care at this time? Check all that apply. (Ctrl+Click to select more than one)
College Health ServicesMedi-cal/MedicaidEmployee health care planShort-term individual plan (i.e. Cobra)Annual/Long-term individual planMilitary health care planParents’ health care plannone use preventive care clinics.none any form of health care.
Do you have “Covered till 26?”:–None–YesNo
10. What agencies have you received assistance from since leaving foster care? Check all that apply.
AB12 Extended Foster CareAssistance Adoption ProgramsCasey Family ServicesCash AidWIC/Food StampsHOMEHHSA (Health Human)Providence Community CenterRegional CenterSDYS SD Youth ServicesSPA San Pasqual AcademySBCS South Bay Comm. ServicesSecond ChanceSocial Security InsuranceTLP Transitional Living ProgramTHP Transition Housing ProgramTrace ProgramWAY Internship ProgramWIA Workforce Investment ActYES Transition NetworkYMCAILS Independent Living ServicesKinship ServicesI have not received any assistanceNot eligible to receive other services
11. What agency assistance are you receiving now? Check all that apply.
AB12 Extended Foster CareAssistance Adoption ProgramsCasey Family ServicesCash AidWIC/Food StampsHOMEHHSA (Health and Human)Providence Community CenterRegional CenterSDYS (San Diego Youth Services)SPA (San Pasqual Academy)SBCS (South Bay Community Services)Second ChanceSocial Security InsuranceTLP Transitional Living ProgramTHP Transitional Housing ProgramTrace ProgramWAY (Internship Program)WIA (Workforce Investment Act)YES Transition NetworkYMCAILS (Independent Living Services)Kinship ServicesI have not received any assistancenot eligible to receive other services
1. What is your current housing situation?
–Choose One–1) Homeless/Couch Surfing2) Transitional Housing/Dorm less than 6 months3) Transitional Housing/Dorm 6 months- 1 year4) Living in Apartment/Home (with or without a roommate) less than 2 years5) Living in Apartment/Home (with or without a roommate) more than 2 years
2. How far are you along in school? Select your highest level of education:
–Choose One–1) No High School Diploma or GED2) Earned High School Diploma or GED3) At least one year of post-secondary school, but no degree4) Completed 2 years of post-secondary school or earned vocational/trade/2-year college degree5) Earned 4-year college degree6) One or more years of graduate school
3. Are you currently enrolled in school?
4. If you are not enrolled in school, what is the reason you are
not enrolled in school this semester/quarter? Check all that apply.
do not have a high school diploma/GEDdo not have the money to paycant work and go to school same timedo not have reliable transportationdo not have a stable place to livehave short-term health problemshave long-term health problemspregnant or primary caregiverdid not sign up/have trouble with papersdo not know how to sign up
5. What type of school program are you currently attending?
–Choose One–High School/GEDCertificate/Technical/Trade/Vocational School2-year Community College4-year University or CollegeGraduate School/Law School
6. What is the name of your school?
7. Student Status
8. What is your declared major/trade?
–Choose One–AgricultureBiology/Physical Science/Life ScienceBusiness/Finance/EconomicsCommunications/Media StudiesComputer Science/ Information SystemsConstruction/Plumbing/ElectricalCosmetology/EsthetologyCriminal Justice/LawCultural Studies/LanguageEducation/ Child DevelopmentEngineering/ArchitectureEnglish/Literature/JournalismHistoryMathematicsMedicine/Healthcare/Pre-MedNursing/Dentistry/Medical AssistingMusic/DancePolitical Science/GovernmentPsychology/Sociology/Social WorkVisual Arts/Graphic DesignWelding/Machining/Auto-MechanicUndecided
9. What year do you expect to graduate college/trade school/ 2-year certificate?
10. What is your cumulative grade point average?
–Choose One–Below 2.02.0-2.4 (D average)2.5-3.0 (C average)3.1-3.4 (B average)3.5-4.0 (A average)
1. What is your current employment status?
–Choose One–1) Unemployed no income/assets2) Seeking a job or temporary seasonal job or other legal income3) Employed in a semi-stable job or business venture4) Permanent and stable job 1-year or maintaining business venture5) Permanent and stable job more than 1-year/maintaining a business more than 1-year
2. If unemployed, what is the reason you are not employed at this time? Check all that apply.
I do not have a high school diploma/GEDI am a student/enrolling in schoolI do not have reliable transportationI do not have a stable place to liveI have short-term health problemsI have long-term health problemsI am pregnant or the primary caregiverCurrently searching for employmentI have had trouble with the lawI have no job experience/never worked
3. How many hours do you work per week?
–Choose One–I am not working at this time.Less than 20 Hours20-34 Hours35-40 HoursMore than 40 Hours
4. What is the name of your employer?
5. What is your hourly wage?
–Choose One–Less than $8.00$8.00-$9.99$10.00-$11.99$12.00-$13.99$14.00 or more
6. What is your current Financial Status?
–Choose One–1) Frequently borrow money, no savings, no budget, cannot support myself at all2) Sometimes borrow money, no savings, unmanageable budget, cannot support myself most of the time3) Rarely borrow money, minimal savings, have a budget, can support myself some of the time4) Rarely-never borrow money, save money regularly, live within a budget, can support myself most of the time5) Never borrow money, savings of $3,000 or more, live within a budget, can support myself fully
1. Description of a caring adult (25+ years): Someone who listens to you when you need to talk, gives you good advice about a crisis, gives you information to help you understand a situation, believes in you and your dreams. Please select the following as it applies to you:
–Choose One–1) I do not have anyone in my life who fits this description2) I have had someone in my life who fits this description for the last 6 months3) I have had someone in my life who fits this description for the last year4) I have had someone in my life who fits this description for the last 2 years5) I have had someone in my life who fits this description for more than 2 years
Please indicate your relation to this caring adult:
–Choose One–N/A I don’t have a caring adult in my life right now.FriendSocial Worker/Case Worker/LawyerRelativeJIT PersonClergy/Teacher/CoachOther
2. What is your level of community service?
–Choose One–1) No Community Service, 0 Hours/Month2) Minimal Community Service, 1-4 Hours/Month3) Moderate Community Service, 5-8 Hours/Month4) High Community Service, 8-12 Hours/Month5) Leadership/Initiation of Community Projects, 13+ Hours/Month
3. Please indicate your perceived level of self-sufficiency. Where do you believe you are right now in your life?
–Choose One–In CrisisAt RiskStableSafeThriving
4. Overall, how satisfied are you with your life?
–Choose One–Not at all satisfiedBarely satisfiedSomewhat satisfiedVery satisfiedExtremely satisfied
1. To effectively help our youth, Just In Time must communicate with all current/former case managers, social workers, college officials, employers, rental companies, volunteers and any other programs related to a former foster youth’s request for assistance. In addition, agencies providing service at the Youth & Family Transition Center may share confidential information and records of individuals requesting service for the purpose of assisting those individuals with their transition to independence.
Please check to indicate you agree to allow Just in Time to obtain any and all information related to your application for services.
2. I release JIT to communicate with the following past/present case managers, advisors, coaches, etc. (Please provide at least one, include phone number and e-mail)
3. What is the primary way you keep up with JIT news and events?
–Choose One–Just In Time web siteFacebook/TwitterE-mail Just In TimeCall Just In Time officeThrough ILS or agency case manager
4. May we use your comments for JIT promotions?
A Youth Services Coordinator will be in contact with you within two business days. Thank you!
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